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GERIATRIC NURSING

ASHIKA SEBASTIAN
Geriatric nursing: geriatric nursing is the
speciality that concerns itself with the
provision of nursing services to geri...


AGING: aging is defined as a maturational
process that creates the need for individual
adaptation because of physical a...
Chronological Age: refers to the number
of years a person has lived. Easy to
identify & measure, it is most commonly
used ...


Functional Age: refers to a person’s ability
to contribute to society and benefits others &
himself. It is based on the...
FACTORS AFFECTING AGING
HEREDITORY FACTORS
 ENVIRONMENTAL FACTORS
ABIOTIC FACTORS
BIOTIC FACTORS
 SOCIOECONOMIC FACTORS
...
ANA STANDARDS OF GERONTOLOGICAL
NURSING PRACTICE (NURSING CARE)
STANDARD I. Assessment:
 The gerontological nurse collect...
STANDARD IV. Planning:
 develops a plan of cares that prescribes
interventions to attain outcomes.
 STANDARD V. Implemen...
ANA STANDARDS OF GERONTOLOGICAL
NURSING PRACTICE (QUALITY CARE)
STANDARD I. Quality of Care:
 The gerontological systemic...
STANDAR III. Education:
 The gerontological nurse acquires and
maintains current knowledge in nursing practice.
 STANDAR...
STANDARD VI. Collaboration:
 collaborates with older adult, the older adults
caregiver, and all member of interdisciplina...
PRINCIPLES OF GERONTOLOGICAL NURSING
PRACTICE
Aging is a natural process common to all
living organisms.
 Various factors...


Gerontological nursing strives to help older
adults achieve optimum levels of physical,
psychological, social and spiri...
THEORIES OF AGING
Biological Theories of Aging-Biological
theories attempt to explain physical aging as
an involuntary pro...
FREE RADICAL THEORY


Free-radical theory emphasizes the mechanism
of oxygen use at the cellular level. Free-radicals
are...
CROSS- LINKED THEORY


The cross-link theory and connective tissue
theory asserts that the molecules of collagen
and elas...
IMMUNOLOGICAL THEORY


the immune system is responsible for aging.
An aging immune system is less able to
distinguish bod...


Error Theory: Error theory focus on the
phenomenon of decreased bonding of
protein cells that occurs spontaneously or i...


Wear-and-Tear Theory: Body cells,
structures and functions wear out or are over
used through exposure to internal and
e...


Somatic Mutation Theory: This theory
suggests that cells exposed to chemicals or
radiation results in alteration within...


DNA Damage Theories: Aging is caused by
accumulated damage to DNA, which in turn
inhibits cells ability to function and...


Programmed Cellular Aging Theory: Suggest
that aging may be result of an impairment of the
cells in translating necessa...


Psychosocial Theories of Aging:
Psychosocial theories of aging attempt to
explain age – related changes in cognitive
fu...
Disengagement Theory: This theory
formulated by Cummings and Henry states
that aging people withdraw from customary
roles ...


Continuity Theory: The continuity or
developmental theory states that personality
remains the same and behaviour become...


Activity Theory: Successful aging and life
satisfaction depend on maintaining high level
of activity. According to this...


Adjustment Theory: Adjustment theory
defines aging as a series of adjustment to
retirement, to grandparenthood, to chan...


Autoimmune theory: proposes that
decrease in immune function may result in
an increase in autoimmune response
causing t...
ASSESSMENT OF OLDER ADULTS
COMPONENTS
1. FUNCTIONAL ASSESSEMENT
Katz Index: It is for activities of daily living is
widely...


Barthel index: This type of tools helps to
assess a patient’s capacity for self care. It
evaluates 10 items: Feeding, M...


Lawton Scale: This is used for instrumental
activities of daily living. This tool evaluates
the patient’s ability to pe...


OARS Social Resources Scale: The Older
Americans Research Service Center[OARS]
social resources scale is a multidimensi...
2. PHYSICAL EXAMINATION
3. NUTRIONAL ASSESSMENT
AGE RELATED BODY SYSTEM CHANGES
Musculoskeletal System

Decreased muscle mass, size and
muscle look smaller.
 Decreased ...
Exaggerated bony prominence.
 Shortening of height as result of
intervertebral space narrowing caused by
water loss
 Syn...
Integumentary System
 Increased dryness of skin.
 Thinning in the layer of the skin.
 Increased pigmentation, causing l...
Decrease in nail growth rate & strength.
 Toenails may discolour.
 Thinning of scalp hair.
 Decrease in melanin, which ...
Cardiovascular system
 Slowed heart rate.
 Reduced ability of the heart to quickly
increases its rate in response to an
...
More irregular heart beats, arrhythmias, which
leads to poor oxygenation of the heart.
 Increased blood pressure – 140/90...
Respiratory System
 Nose enlargement from continued cartilage
growth.
 Increased antero – posterior diameter.
 Increase...
Increased size of alveoli.
 Increased airway resistance.
 Decrease in lung’s elastic recoil capability.
 Dilation of br...
Gastrointestinal System
 Decreased saliva production, increased
dryness.
 Changes in taste and smell.
 Decreased gag re...
No functional changes in small intestine.
 Decreased tone in bowel wall & anal
sphincter.
 Alterations in bowel habits –...
Genitourinary System
 Decreased kidney size, function & output.
 Decreased golmerular filtration.
 Reduced renal blood ...
Decreased number of nephrons.
 Decreased bladder size and tone.
 Incomplete bladder emptying & chronic
urine retention f...
Endocrine System
 Decreased pancreatic insulin release & peripheral
sensitivity.
 Decreased glucose tolerance with advan...
Neurological System
 Progressive loss of brain cells.
 Decreased blood flow & oxygen utilization
to brain.
 Increased s...
Decreased reflex with increased nerve
conduction rate.
 Decreased ability of the hypothalamus to
regulate body temp.
 De...
SENSORY SYSTEM

Eye and vision
 Decreased visual acquity.
 Eyelids loss their elasticity.
 Conjunctiva become thinner&...
Impaired colour vision.
 Sclera becomes thick & rigid and fat deposits
cause yellowing.
 Diminished night vision and dep...
Taste
 Decreased taste perception.
 Reduction in number of functioning taste
buds.
 Decreased amount of saliva.
 Smell...
IMMUNOLOGICAL SYSTEM
 Decreased immune response.
 Decreased antibody response make them
more susceptible to infection.
...
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REPRODUCTIVE SYSTEM
Male reproductive system
Decreased testosterone production cause
decrease libid...
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Female reproductive system
Decreased vaginal lubrication, dry, pale, and less elastic.
Thinn...
COGNATIVE CHANGES OF NORMAL AGING
Factors affects cognition
 Sensory changes and disease associated
with ages.
 Pain fro...
Changes in memory
 Short –term memory, which is associated with
decreased judgement, insight, and orientation.
 Gradual ...
PSYCHOSOCIAL ASPECTS OF AGING
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RETAIREMENT

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ROLE CHANGES

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LONELINESS

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DEPRESSION AND SUICIDE
COMMON MEDICAL PROBLEMS IN OLD AGE
PRESSURE ULCERS
 Prevention of pressure ulcers
 Monitor the pressure areas by measuri...
CARDIOVASCULAR DISEASES
 RESPIRATORY DISEASES
 GENITOURINARY SYSTEM
urinary incontienence

GASTROINTESTINAL DISEASES
interventions
 Promote normal bowel elimination.
 Remove faecal impactions.
 Palpate patients...
NEUROLOGIC DISEASES
Interventions:
 Watch for anxiety
 Speak to the patient slowly in a soft and
clam voice.
 Assess th...
ENDOCRINE DISEASES
 Interventions:
 Obtain current weight and weight history of
the patient.
 Assess signs for hypoglyc...
MUSCULOSKETAL DISEASES
Interventions:
 Assess the signs and symptoms of pain.
 Apply ice pack to the joint
 Administer ...
MEDICATION IN ELDERLY
Major problems with prescriptive medication
include adverse effect, medication
intervention, medicat...
Medication dosage normally as prescribed at
one third to one half of normal adult dose.
 Closely monitor client for adver...
Asses for medication interaction in the client
taking multiple medication.
 Advise the client to use one pharmacy &
notif...
Administration of medication
 Place the client in a sitting position when
administering medication taken.
 Check for mou...
Do not crush –entric- coated tablets& do
not open capsules.
 If administering a suppository do not insert
suppository imm...
Do not use an immobile limb for administering
parentral medication.
 Monitor client compliance with taking prescribed
med...
ABUSE OF THE OLDER ADULTS
Abuse involves physical emotional or sexual
abuse & also can involve neglect or
economic explora...
STRESS AND COPING IN ELDERLY
Common stressors of old age include:
 Normal aging changes that impair physical
function, ac...
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Some suggestions may help to reduce the stress
Take one think at a time.
Be realistic
Visualization...
USE OF AIDS AND PROSTHESIS
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PROSTHESIS: Prosthesis is an artificial
device used to replace a missing body part
such as a...
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DENTAL PROSTHESIS: is an artificial
appliance which is used as a substitution for
the replacement of teeth. In certain
...
ADVANTAGES
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Mastication: chewing ability is improved by
replacing edentulous areas with denture teeth.
Aesthesti...
HEARING AIDS
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A hearing aid is an electroacoustic body worn
apparatus which typically fits in or behind the
wearer’s ear...
TYPES OF HEARING AIDS
POCKET MODEL
 BEHIND THE EAR(BTE)
 IN THE EAR(ITE)
 IN THE CANAL, (ITC)MINI CANAL ( MIC),
COMPLET...
Care and maintenance of hearing aids
 Prevent it from falling down
 Don’t spill liquids on the hearing aids
 The hearin...
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Acute Care
Gather medical, family and psychological history
Perform patient assessment
Explain...
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Long Term care
Gather medical, family, and psychological history
Perform patient assessment
Invo...
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Community care
Identify health, social, or economic needs
Refer elderly person to professional or ot...
SPECIAL CONSIDERATIONS IN CARE OF ELDERLY
 Promotion of self respect and dignity
 Promotion of comfort
 Safety
 Daily ...
LEGAL AND ETHICAL ISSUES
Informed consent
 Autonomy
 Euthanasia
 Assisted suicide
 Palliation
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COMMUNITY AND INSTITUTIONAL HEALTH CARE
SERVICES
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HOME CARE: home care is a range of
health & supportive services provid...
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HOSPICE CARE: A hospice is a resources
for the terminally ill. A hospice can be
independent unit within the community t...
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RESPITE CARE: Respite care provides
caregiver relief for a brief, time – limited
period. It can be offered in the home,...
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DAY CARE: Day care provides an alternative
to institutionalization. Offering health &
rehabilitative services. Day care...
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SENIOR CENTERS: Senior centers offer a
variety of social, health, and nutritional ,
educational and recreational servic...
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CHECK – IN SERVICE: Some senior
centers, churches and other community
agencies offer telephone check – in services,
in ...
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LONG TERM CARE: It refers to a
continuum of services, including medical
care, nursing care & personnel or
psychological...
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EMERGENCY RESPONSE SYSTEM : ERS
provide a link between the elder living alone
& emergency services. The ERS when
activa...
NURSING DIAGNOSIS
Social isolation related to inadequate
individual resources
 Health seeking behaviours related to home
...
INTERVENTIONS
 Actively listen to the client
 Give positive reinforcement
 Helps the client to explore the causes of
so...
Nursing Diagnosis
 Risk for impaired ski integrity related to urinary
incontinence
INTERVENTIONS
 Assess the perineal ar...
Nursing diagnosis
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Self – care deficit related to increased
forgetfulness secondary to disease
progression
Intervention
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Azhar kappil geriatric nsg ppt

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GERIATRIC NURSING

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Azhar kappil geriatric nsg ppt

  1. 1. GERIATRIC NURSING ASHIKA SEBASTIAN
  2. 2. Geriatric nursing: geriatric nursing is the speciality that concerns itself with the provision of nursing services to geriatric or aged individuals.  It is defined as the specialized nursing care of the older adults that occurs in any setting in which nurse use, knowledge, expertise and caring abilities o promote optimal functioning. 
  3. 3.  AGING: aging is defined as a maturational process that creates the need for individual adaptation because of physical and psychological declines that occurs during life time.
  4. 4. Chronological Age: refers to the number of years a person has lived. Easy to identify & measure, it is most commonly used objective method.  Physiological Age: refers to the determination of age by body function. Although age related changes affect every one, it is impossible to pinpoint exactly when these changes occur. That is why physiological age is not useful in determining a person’s age. 
  5. 5.  Functional Age: refers to a person’s ability to contribute to society and benefits others & himself. It is based on the fact that not all individuals of the same chronological age function at the same level.
  6. 6. FACTORS AFFECTING AGING HEREDITORY FACTORS  ENVIRONMENTAL FACTORS ABIOTIC FACTORS BIOTIC FACTORS  SOCIOECONOMIC FACTORS 
  7. 7. ANA STANDARDS OF GERONTOLOGICAL NURSING PRACTICE (NURSING CARE) STANDARD I. Assessment:  The gerontological nurse collects patient health data.  STANDARD II. Diagnosis:  The gerontological nurse analyzes the assessment data in determining diagnoses  STANDAR III. Outcome identification:  The gerontological nurse identifies expected outcomes individualize to the older adult. 
  8. 8. STANDARD IV. Planning:  develops a plan of cares that prescribes interventions to attain outcomes.  STANDARD V. Implementations:  implements the interventions identified in the plan of care.  STANDARD VI. Evaluation:  evaluates the older adults progress towards attainment of expected outcomes. 
  9. 9. ANA STANDARDS OF GERONTOLOGICAL NURSING PRACTICE (QUALITY CARE) STANDARD I. Quality of Care:  The gerontological systemically evaluates the quality of care and effectiveness of nursing practice.  STANDARD II. Performance Appraisal:  The gerontological nurse evaluates his/her own nursing practice in relation to professional practice standards and relevant statutes and regulations 
  10. 10. STANDAR III. Education:  The gerontological nurse acquires and maintains current knowledge in nursing practice.  STANDARD IV. Collegiality:  contributes to professional development of peers, colleagues and others.  STANDARD V. Ethics:  decisions and actions on behalf of older adults are determined in an ethical manner. 
  11. 11. STANDARD VI. Collaboration:  collaborates with older adult, the older adults caregiver, and all member of interdisciplinary team to provide comprehensive care.  13. STANDARD VII. Research:  interprets applies and evaluates research findings to improved gerontological nursing practice.  STANDARD VIII. Resource Utilization:  considers the factors related to safety, effectiveness and cost in planning and delivering patient care. 
  12. 12. PRINCIPLES OF GERONTOLOGICAL NURSING PRACTICE Aging is a natural process common to all living organisms.  Various factors influence the aging process.  Unique data and knowledge are used in applying the nursing process to the older populations.  The elderly share similar self-care and human needs with all other human beings. 
  13. 13.  Gerontological nursing strives to help older adults achieve optimum levels of physical, psychological, social and spiritual and spiritual health so that the can achieve wholeness
  14. 14. THEORIES OF AGING Biological Theories of Aging-Biological theories attempt to explain physical aging as an involuntary process, which eventually leads to cumulative changes in cells, tissues and fluid.  Intrinsic Biological Theory-Intrinsic biological theory maintains that aging changes arise from internal, predetermined causes.  Extrinsic Biological Theory-Extrinsic biological theory maintains that environmental factors lead to structural alterations, which, in turn, cause degenerative changes. 
  15. 15. FREE RADICAL THEORY  Free-radical theory emphasizes the mechanism of oxygen use at the cellular level. Free-radicals are molecule with an extra cellular charge. This charge creates a reaction that alters the structure or function of the cell membrane. Increased unstable free-radicals produces effect harmful to biological systems, such as chromosomal changes, pigment accumulation and collagen alteration
  16. 16. CROSS- LINKED THEORY  The cross-link theory and connective tissue theory asserts that the molecules of collagen and elastin, connective tissue components, from bonds that increase cell rigidity. Crosslinkage is thought to results from chemical reaction that creates chemical bonds between normally separate molecules in the body.
  17. 17. IMMUNOLOGICAL THEORY  the immune system is responsible for aging. An aging immune system is less able to distinguish body cells from foreign cells; as a result, it begins to attack and destroy body cells as if they were foreign. Erratic cellular mechanisms are thought to attack on body tissues through auto aggression or immunodefiency.
  18. 18.  Error Theory: Error theory focus on the phenomenon of decreased bonding of protein cells that occurs spontaneously or in response to stressors such as radiation. This stressors results in errors in the synthesis of RNA and DNA and produces cells with impaired function.
  19. 19.  Wear-and-Tear Theory: Body cells, structures and functions wear out or are over used through exposure to internal and external stressors. Effects from the residual damage accumulate, the body can so longer resist stress and death occurs. Repeated injury or overuse; internal and external stressors, including trauma, chemicals and build up of naturally occurring waste.
  20. 20.  Somatic Mutation Theory: This theory suggests that cells exposed to chemicals or radiation results in alteration within the DNA molecule. Mutation results from these alterations accumulate overtime and become more evident with age and increasing cellular impairment
  21. 21.  DNA Damage Theories: Aging is caused by accumulated damage to DNA, which in turn inhibits cells ability to function and express the appropriate genes. This lead to cell death and overall aging of the organism
  22. 22.  Programmed Cellular Aging Theory: Suggest that aging may be result of an impairment of the cells in translating necessary RNAs as a result of increased turnoffs of DNA. In other words, the transcription of these messages into functional protein may be restricted in older people. Some segments of DNA become depleted with advancing age, or selected cellular structures seem to change with so that DNA transcription is restricted.
  23. 23.  Psychosocial Theories of Aging: Psychosocial theories of aging attempt to explain age – related changes in cognitive function, such as intelligence, memory, learning and problem – solving
  24. 24. Disengagement Theory: This theory formulated by Cummings and Henry states that aging people withdraw from customary roles and engage in more introspective, selffocused activities. This theory includes 4 basic concepts:  Aging person and society mutually withdraw from each other.  Disengagement is biologically and psychologically intrinsic and inevitable.  Disengagement is considered necessary for successful aging.  Disengagement is beneficial for older adults and society 
  25. 25.  Continuity Theory: The continuity or developmental theory states that personality remains the same and behaviour become more predictable as people age. This theory focuses more personality and individual behaviour over time.
  26. 26.  Activity Theory: Successful aging and life satisfaction depend on maintaining high level of activity. According to this perspective, the maintenance of optimal physical, mental and social activity is necessary for successful aging this theory also assumes that older adults have the same needs as middle-age persons
  27. 27.  Adjustment Theory: Adjustment theory defines aging as a series of adjustment to retirement, to grandparenthood, to change in income, to changes in social life and marital status and to potential deterioration of health and well being.
  28. 28.  Autoimmune theory: proposes that decrease in immune function may result in an increase in autoimmune response causing the body to produce antibodies that attack itself.
  29. 29. ASSESSMENT OF OLDER ADULTS COMPONENTS 1. FUNCTIONAL ASSESSEMENT Katz Index: It is for activities of daily living is widely used for evaluating a patient’s ability to perform daily personal self care activities. This tool ranks the patient’s ability to perform six function: Bathing, Dressing, Toileting, Continence and Feeding 
  30. 30.  Barthel index: This type of tools helps to assess a patient’s capacity for self care. It evaluates 10 items: Feeding, Moving from wheel chair to bed and returning, Getting on and off the toilet, Walking on a level surface or propelling a wheel chair, going up and down stairs, dressing and under dressing, maintaining bowel incontinence and controlling bladder.
  31. 31.  Lawton Scale: This is used for instrumental activities of daily living. This tool evaluates the patient’s ability to perform more complex personal care activities needs to support independent living, such as ability to use the telephone, shop, do laundry, manage finance, take medications and prepare meals.
  32. 32.  OARS Social Resources Scale: The Older Americans Research Service Center[OARS] social resources scale is a multidimensional assessment tool developed at Duke University in 1978. It evaluates level of function in 5 areas: Social recourses, Economic resources, Physical health, Mental health and Activities of daily living.
  33. 33. 2. PHYSICAL EXAMINATION 3. NUTRIONAL ASSESSMENT
  34. 34. AGE RELATED BODY SYSTEM CHANGES Musculoskeletal System  Decreased muscle mass, size and muscle look smaller.  Decreased in muscle tone.  Decreased amount of elastic tissue.  Slower muscle response.  Decrease in elasticity of tendons & ligaments.  Decreased range – of – motion – stiffness.  Decreased joint mobility.  Osteoporosis – thinning and softening of the bone. 
  35. 35. Exaggerated bony prominence.  Shortening of height as result of intervertebral space narrowing caused by water loss  Synovial fluid becomes more viscous.  Increased collagen formation, which cause loss of resilience & elasticity in joints. 
  36. 36. Integumentary System  Increased dryness of skin.  Thinning in the layer of the skin.  Increased pigmentation, causing liver/ aging spot.  Decreased elasticity of skin, causing wrinkling.  Decreased subcutaneous fat layer of skin.  Decreased perspiration  Facial lines around the eye, mouth and nose.  Hardness & dryness of nail, making them more brittle.
  37. 37. Decrease in nail growth rate & strength.  Toenails may discolour.  Thinning of scalp hair.  Decrease in melanin, which result in gray hair.  Hormonal changes cause pubic hair loss.  Increased growth of nose, ear & facial hair.  Slight growth of hair on upper lip & chin in postmenopausal women.  Decreased sebaceous & sweat glands, which has implications for dryness & decreased temperature regulation. 
  38. 38. Cardiovascular system  Slowed heart rate.  Reduced ability of the heart to quickly increases its rate in response to an emergency because of thickening of heart valves, left ventricle and aorta.  Decreased stroke volume & cardiac output.  Decreased elasticity of blood vessels.  Increased rigidity & thickening of valves.
  39. 39. More irregular heart beats, arrhythmias, which leads to poor oxygenation of the heart.  Increased blood pressure – 140/90 – 160/100.  Increased peripheral vascular resistance.  More visible superficial blood vessels of legs.  Common diastolic murmur.  Weaken pedal pulse & colder lower extremities. 
  40. 40. Respiratory System  Nose enlargement from continued cartilage growth.  Increased antero – posterior diameter.  Increased chest rigidity.  Increased respiratory rate with decreased lung expansion.  Decreased diffusion capacity of the lungs.  Decreased total pulmonary surface area for gas exchange.  Decreased inspiratory & expiratory muscle strength diminishes vital capacity.
  41. 41. Increased size of alveoli.  Increased airway resistance.  Decrease in lung’s elastic recoil capability.  Dilation of bronchioles & ducts.  Weaker cough or gag reflex,  Decreased depth of respiration & oxygen intake. 
  42. 42. Gastrointestinal System  Decreased saliva production, increased dryness.  Changes in taste and smell.  Decreased gag reflex.  Decreased motility, peristalsis in stomach.  Decreased production of GI secretions – HCL, Pepsin.  Delayed gastric emptying.
  43. 43. No functional changes in small intestine.  Decreased tone in bowel wall & anal sphincter.  Alterations in bowel habits – constipation.  Decreased liver weight & Decreased blood flow.  Marked decline in liver enzymes which affects drug metabolism and detoxification. 
  44. 44. Genitourinary System  Decreased kidney size, function & output.  Decreased golmerular filtration.  Reduced renal blood flow from decreased cardiac output.  Decreased efficiency of kidney to concentrate urine.  Diminished kidney filtration rate & tubular function, which cause a decrease in the renal clearance of drugs.
  45. 45. Decreased number of nephrons.  Decreased bladder size and tone.  Incomplete bladder emptying & chronic urine retention from weakness of bladder muscle.  Increased ease of backflow of urine.  Decreased bladder capacity.  Increased residual urine frequency & nocturia.  Increased incidence of UTIs.  Increased plasma urea & uric acid. 
  46. 46. Endocrine System  Decreased pancreatic insulin release & peripheral sensitivity.  Decreased glucose tolerance with advancing age.  Alteration in hormone production.  Decreased secretion of estrogen, FSH & LH  Decreased secretion of progesterone & testosterone.  Decreased production of rennin, angiotensin, & erythropoietine.  Decreased secretion of aldosterone contributes to decreased sodium reabsorption  Decreased secretion of ADH contributes to decreased water reabsorption.  Decreased secretion of thymosin & thyroxin.
  47. 47. Neurological System  Progressive loss of brain cells.  Decreased blood flow & oxygen utilization to brain.  Increased size of ventricles and thinning of cortex.  Decreased number of neurons, neurotransmitters & nerve conduction.  Increased length of dendrities & number of synapse
  48. 48. Decreased reflex with increased nerve conduction rate.  Decreased ability of the hypothalamus to regulate body temp.  Decreased sense of balance or equilibrium.  Decrease sensitivity & sensation.  Irregular sleep stages.  Decreased motor coordination response. 
  49. 49. SENSORY SYSTEM  Eye and vision  Decreased visual acquity.  Eyelids loss their elasticity.  Conjunctiva become thinner& yellow.  Quantity of tears decreases.  Decreased pupil size & speed of adjusting to change in light.  Decreased ciliary muscle efficiency.  Decreased accommodation due to impaired lens elasticity.  Lens enlarges and loses transparency. 
  50. 50. Impaired colour vision.  Sclera becomes thick & rigid and fat deposits cause yellowing.  Diminished night vision and depth of perception. Ears and Hearing  Decreased elasticity of eardrum.  Diminished hearing acquity.  Decreased ability to hear high- pitched sound.  Gradual cerumen accumulation.  Slowly progressive deafness- prebycusis or senile deafness 
  51. 51. Taste  Decreased taste perception.  Reduction in number of functioning taste buds.  Decreased amount of saliva.  Smell  Decreased sense of smell.  Decreased number of olifactory neurons.  Touch  Decreased deep sensation.  Decreased vibratory sense & pain awareness.  Decreased temperature regulation. 
  52. 52. IMMUNOLOGICAL SYSTEM  Decreased immune response.  Decreased antibody response make them more susceptible to infection.  Decreased number & function of T-cells.
  53. 53.           REPRODUCTIVE SYSTEM Male reproductive system Decreased testosterone production cause decrease libido. Decrease size and firmness of testes. Prostate gland enlarges and secretion decreases. Seminal fluid decreases in volume& less viscous. Decreased intensity of sensation. Decreased speed of erection & force of ejaculation. Decreased sperm count. Increased dysuria.
  54. 54.               Female reproductive system Decreased vaginal lubrication, dry, pale, and less elastic. Thinning & shortening of vaginal wall. Vaginal acidity reduced. Decreased size of labia and clitoris. Decreased quantity of pubic hair. Ovaries atrophy and become thinner & smaller. Uterus becomes smaller and less firm. Decreased secretion of estrogen, progesterone, FSH& LH Cessation of menses after menopause. Breasts become pendulous. Nipples decrease in size and become flat. Glandular, supporting & fatty tissue atrophy. Degenerative changes in the gonads lead to abrupt cessation of the menses
  55. 55. COGNATIVE CHANGES OF NORMAL AGING Factors affects cognition  Sensory changes and disease associated with ages.  Pain from chronic disease  Sleep deprivation  Medications side effects  Changes in mental functioning  range of interests, and understanding.  Increased repetitive thoughts and vulnerability to stress. 
  56. 56. Changes in memory  Short –term memory, which is associated with decreased judgement, insight, and orientation.  Gradual memory loss  Learning and intelligence  Aging may affect learning.  Hesitancy in answering questions or repeating information.  Intelligence does not declines as on age. 
  57. 57. PSYCHOSOCIAL ASPECTS OF AGING  RETAIREMENT  ROLE CHANGES  LONELINESS  DEPRESSION AND SUICIDE
  58. 58. COMMON MEDICAL PROBLEMS IN OLD AGE PRESSURE ULCERS  Prevention of pressure ulcers  Monitor the pressure areas by measuring length, width and depth of to gauge of the ulcers  Turn the patient ever two hours  Keep the patient skin clean and dry  Place the pillow between the pressure areas to prevent friction and pressure  Teach the active and passive exercises  Use paper tape to secure dressing 
  59. 59. CARDIOVASCULAR DISEASES  RESPIRATORY DISEASES  GENITOURINARY SYSTEM urinary incontienence 
  60. 60. GASTROINTESTINAL DISEASES interventions  Promote normal bowel elimination.  Remove faecal impactions.  Palpate patients abdomen and auscultate for bowel sounds  Monitor the patent use of laxative and enema.
  61. 61. NEUROLOGIC DISEASES Interventions:  Watch for anxiety  Speak to the patient slowly in a soft and clam voice.  Assess the patients needs for assistance.  Give the patient plenty of time to complete task.  Provide small frequent feeding  Assess the patient ability to swallow 
  62. 62. ENDOCRINE DISEASES  Interventions:  Obtain current weight and weight history of the patient.  Assess signs for hypoglycaemia  Monitor intake and out put  Administer intravenous insulin  Administer intravenous fluid  Explain all the procedure to the patient 
  63. 63. MUSCULOSKETAL DISEASES Interventions:  Assess the signs and symptoms of pain.  Apply ice pack to the joint  Administer acetaminophen  Teach the patient about active and passive exercise  Encourage the patient to avoid walking down stairs  Teach the patient to organize the activities of daily living. 
  64. 64. MEDICATION IN ELDERLY Major problems with prescriptive medication include adverse effect, medication intervention, medication errors, non compliance and cost.  Determine the use over the counter medications.  Polypharmacy 
  65. 65. Medication dosage normally as prescribed at one third to one half of normal adult dose.  Closely monitor client for adverse effect& response to therapy because the increased risk for medication toxicity.  Note that a common sign of an adverse effect in the older client is an acute change in mental status. 
  66. 66. Asses for medication interaction in the client taking multiple medication.  Advise the client to use one pharmacy & notify the consulting physician of the medication taken. 
  67. 67. Administration of medication  Place the client in a sitting position when administering medication taken.  Check for mouth dryness because medication may stick & dissolve the mouth.  Administer liquid preparation if the client has difficulty in swallowing.  Crush tablets if necessary & give with textured food, if not contraindicated.  Do not crush –entric- coated tablets& do not open capsules.
  68. 68. Do not crush –entric- coated tablets& do not open capsules.  If administering a suppository do not insert suppository immediately after removing the refrigerator.  A suppository may take longer time to dissolve because decreased body core temperature.  When administering parentral medication, monitor the site it may ozze medication or bleed because of decreased tissue elasticity. 
  69. 69. Do not use an immobile limb for administering parentral medication.  Monitor client compliance with taking prescribed medication.  Monitor client for safety in correctly taking medications including an assessment of their ability to read the instructions & discriminate among the pills& their colour & shape.  Use medication cassette to facilitate proper administration of medication. 
  70. 70. ABUSE OF THE OLDER ADULTS Abuse involves physical emotional or sexual abuse & also can involve neglect or economic exploration  Categories of mistreatment domestic mistreatment Institutional mistreatment Self neglect 
  71. 71. STRESS AND COPING IN ELDERLY Common stressors of old age include:  Normal aging changes that impair physical function, activities and appearance.  Disabilities and chronic illness.  social and environment losses of income, roles and activities.  Death or illness of significant others.  Physical and sexual abuse.  Depression, heavy drinking, or insufficient sleep.  Social issues, such as social defeat, or relationship conflict. 
  72. 72.           Some suggestions may help to reduce the stress Take one think at a time. Be realistic Visualization – imagination hoe you can manage a stressful situation. Meditation – 5-10 min of meditation can bring some relief. Exercise Hobbies Be flexible and clam Adopt healthy life style Share feelings with family members or friends.
  73. 73. USE OF AIDS AND PROSTHESIS  PROSTHESIS: Prosthesis is an artificial device used to replace a missing body part such as a limb, tooth, eye or heart valve. Prosthesis refers to the replacement of the missing body part with such a device. In medicine, prosthesis is an artificial extension that replaces a missing body part.
  74. 74.  DENTAL PROSTHESIS: is an artificial appliance which is used as a substitution for the replacement of teeth. In certain conditions of missing teeth empty space between teeth can lead to teeth shifts to compensate for the space.
  75. 75. ADVANTAGES     Mastication: chewing ability is improved by replacing edentulous areas with denture teeth. Aesthestics: the presence of teeth provide a natural facial appearance, and wearing a denture to replace missing teeth provides support for the lips and cheeks and corrects the collapsed appearance that occur after losing the teeth. Phonetics: by replacing missing teeth, especially the anteriors patients are better able to speak by improving pronunciation of those words containing siblints or fricatives. Self esteem: patients feel better about themselves.
  76. 76. HEARING AIDS  A hearing aid is an electroacoustic body worn apparatus which typically fits in or behind the wearer’s ear and is designated to amplify and modulate sound for the wearer. Earlier devices, known as an “ear trumpet’ or “ear horn”.
  77. 77. TYPES OF HEARING AIDS POCKET MODEL  BEHIND THE EAR(BTE)  IN THE EAR(ITE)  IN THE CANAL, (ITC)MINI CANAL ( MIC), COMPLETELY IN THE CANAL(CIC)  SPECIAL TYPE  REMOTE MICROPHONE  BONE CONDUCTION HEARING AIDS 
  78. 78. Care and maintenance of hearing aids  Prevent it from falling down  Don’t spill liquids on the hearing aids  The hearing aids should be fitted well  Cords should not be twisted or knotted  Protect it from dust, dirt &heat  Remove the battery from hearing aids when it is not in use  The receiver should not come in contact with water
  79. 79.             Acute Care Gather medical, family and psychological history Perform patient assessment Explain diagnosis and treatment to the patient and family Work closely with patient, family, and other health care professionals to develop a good nursing care plan suitable for each patient. Foster elderly patients independence Provide medication and treatments and evaluate responses Maintain hydration, nutrition, aeration and evaluate response Administer emergency treatment when necessary Initiate discharge planning & coordinate referral to community agencies. Serve as patient advocate Inform doctor of any change patient condition
  80. 80.             Long Term care Gather medical, family, and psychological history Perform patient assessment Involve patient and family preparation and implementation of nursing plans. Promote the atmosphere that emphasises quality living, not diseases and dying. Ensure that patient receives, medical, dental and eye care. Maintain hydration, nutrition, aeration comfort of elderly. Provide medications, treatments, rehabilitative exercises and evaluate responses. Treat and advice patient and family. Become knowledgeable person and refer the patient and family to appropriate sections. Perform emergency measures when necessary. Inform doctor of change of patients condition.
  81. 81.           Community care Identify health, social, or economic needs Refer elderly person to professional or other agencies, to suit their needs. Explain diagnosis and treatment to patient and family Evaluate compliance with response to treatments Use clinics and home visits for health promotion Teach and advise patient and family Evaluate elderly persons ability to live independently Become advocate for elderly persons Encourage elderly person to become advocate on his own behalf.
  82. 82. SPECIAL CONSIDERATIONS IN CARE OF ELDERLY  Promotion of self respect and dignity  Promotion of comfort  Safety  Daily living activities  Promotion of independence  Promotion of movement and mobility  Use of meditation in elderly  rehabilitation
  83. 83. LEGAL AND ETHICAL ISSUES Informed consent  Autonomy  Euthanasia  Assisted suicide  Palliation 
  84. 84. COMMUNITY AND INSTITUTIONAL HEALTH CARE SERVICES  HOME CARE: home care is a range of health & supportive services provided in the home for people who require assistance in meeting their health care needs. These agencies may be governmental, private or voluntary.
  85. 85.  HOSPICE CARE: A hospice is a resources for the terminally ill. A hospice can be independent unit within the community that provides support to the client & family in the home or it may be contained within an institution. The programme focused on meeting the needs of the dying patient and family.
  86. 86.  RESPITE CARE: Respite care provides caregiver relief for a brief, time – limited period. It can be offered in the home, through a day care program or within a facility or institution. An advantage in the home, is that the patient is familiar with physical environment.
  87. 87.  DAY CARE: Day care provides an alternative to institutionalization. Offering health & rehabilitative services. Day care center clients are usually not seriously ill, although they may have chronic conditions or disabilities that limit independence. These individuals cannot be left alone during the day when family members are at work or unavailable.
  88. 88.  SENIOR CENTERS: Senior centers offer a variety of social, health, and nutritional , educational and recreational services. They give older people the opportunity to gather for social activity. Besides being meting places, senior center offers councelling, special trips, legal services & advice on financial matters.
  89. 89.  CHECK – IN SERVICE: Some senior centers, churches and other community agencies offer telephone check – in services, in which a volunteer phone a client at a certain time each day to ascertain his status & to provide social contact.
  90. 90.  LONG TERM CARE: It refers to a continuum of services, including medical care, nursing care & personnel or psychological services. Long term care services provide care for people at varying levels of dependence who will require care for an extended period.
  91. 91.  EMERGENCY RESPONSE SYSTEM : ERS provide a link between the elder living alone & emergency services. The ERS when activated can dispatch police an ambulance or other appropriate services to the individuals home. ERS alarm may warn as jewellery, may be attached to the telephone or may be placed next to the bed or bathroom.
  92. 92. NURSING DIAGNOSIS Social isolation related to inadequate individual resources  Health seeking behaviours related to home safety measures that prevents falls  Impaired home maintence management related to inadequate social support system 
  93. 93. INTERVENTIONS  Actively listen to the client  Give positive reinforcement  Helps the client to explore the causes of social isolation  Assist the client to develop a plan of action  Assess the client’s home for safety hazards  Explore the health status of all family members  Initiate referrals  Arrange for additional support for care givers
  94. 94. Nursing Diagnosis  Risk for impaired ski integrity related to urinary incontinence INTERVENTIONS  Assess the perineal area for signs of skin breakdown  Change the continence pad immediately after an episode of urinary incontinence  Provide proper perineal care.  Apply a moisture cream barrier to the perineal area  Instruct the female patient to avoid using feminine hygiene products 
  95. 95. Nursing diagnosis  Self – care deficit related to increased forgetfulness secondary to disease progression Intervention  Assess patient need for assistance  Give the patient plenty of time to complete task  Maintain or ensure physical activity as tolerated and range of motion exercise to maintain mobility 
  96. 96. THANK YOU

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